Extent to which accepted serum lipid goals are achieved in a contemporary general medical population with coronary heart disease risk equivalents

This study examined lipid levels and the use of lipid-altering drugs in a contemporary general medical population without documented coronary heart disease (CHD) but with CHD risk equivalents. On the basis of present national guidelines, the following lipid values (in milligrams per deciliter) were considered optimal for this population: low-density lipoprotein cholesterol <100, high-density lipoprotein (HDL) cholesterol >or=40 in men and >or=50 in women, and non-HDL cholesterol <130 if triglycerides are >or=200. Of 44,052 active patients screened, 877 with CHD risk equivalents as defined by the Adult Treatment Panel III guidelines were identified. Most patients did not meet optimal lipid targets for low-density lipoprotein cholesterol (59%), HDL cholesterol (66%), and non-HDL cholesterol (72%). Indeed, 88% of patients did not meet >or=1 lipid goal. Statins were used in 57% of patients. In patients with low HDL cholesterol, only 4.7% were taking niacin and 4.9% fibrates. In the subgroup of patients with triglycerides >or=200 mg/dl, only 9.5% were taking fibrates and 8.2% niacin. In conclusion, the present analysis highlights the dramatic need to further improve preventive measures in a substantial proportion of high-risk patients with CHD risk equivalents.     

Determination of the solute removal index for urea by using a partial spent dialysate collection method

In 22 hemodialysis patients, during a dialysis session, the solute removal index (SRI) for urea obtained from the use of a partial spent dialysate collection method was compared with that derived from the use of a total spent dialysate collection technique. The partial spent dialysate collection method was used to harvest a small representative sample of the total spent dialysate. The volumes of spent dialysate collected by the partial and the total spent dialysate collection methods were 1.7 +/- 0.4 L and 129.6 +/- 15.3 L, respectively. The total amount of urea nitrogen removed by dialysis as estimated by the partial spent dialysate collection method was similar to that determined by the total spent dialysate collection approach. As a result, the SRI value for urea obtained by the partial spent dialysate collection method (namely, 63% +/- 8%) correlated very well (r = 0.95, P < 0.001) with that derived by the total spent dialysate collection technique (namely, 62% +/- 8%). Our data suggest that it is feasible to use a simple partial spent dialysate collection method to obtain SRI results in patients treated with hemodialysis.     

Cell-bound complement activation products as lupus biomarkers: diagnosis,monitoring and stratification

Introduction: Cell-bound complement activation products (CB-CAPs) were first reported in 2004, since which time multiple laboratories have demonstrated their value as biomarkers for diagnosis, monitoring, and stratification of patients with systemic lupus erythematosus.

Areas covered: This review summarizes the highlights of these 14 years of CB-CAPs discovery and validation, concluding with a view toward their future potential for precision medicine.

Expert commentary: The practice of medicine is both art and science and each physician can be considered both artist and scientist with a variable blend of the two skill sets. There is arguably no disease that presents a greater challenge, nor a greater opportunity, for implementation of precision medicine, as does lupus. The physician who is presented with diagnosis and/or management of a patient suspected of having lupus will need to augment artistic skills with scientific guidance, and that science will be delivered in the form of biomarkers. Ultimately, we will likely have a ‘lupus liquid biopsy’ that will be 100% sensitive and 100% specific for a diagnosis of lupus. This will undoubtedly be a panel of biomarkers rather than an individual laboratory test. Such a liquid biopsy could transform lupus diagnosis to an entirely scientific process.     

A systematic review of the utility of 1.5 versus 3 Tesla magnetic resonance brain imaging in clinical practice and research

Objective

MRI at 3?T is said to be more accurate than 1.5?T MR, but costs and other practical differences mean that it is unclear which to use.

Methods

We systematically reviewed studies comparing diagnostic accuracy at 3?T with 1.5?T. We searched MEDLINE, EMBASE and other sources from 1 January 2000 to 22 October 2010 for studies comparing diagnostic accuracy at 1.5 and 3?T in human neuroimaging. We extracted data on methodology, quality criteria, technical factors, subjects, signal-to-noise, diagnostic accuracy and errors according to QUADAS and STARD criteria.

Results

Amongst 150 studies (4,500 subjects), most were tiny, compared old 1.5?T with new 3?T technology, and only 22 (15?%) described diagnostic accuracy. The 3?T images were often described as “crisper”, but we found little evidence of improved diagnosis. Improvements were limited to research applications [functional MRI (fMRI), spectroscopy, automated lesion detection]. Theoretical doubling of the signal-to-noise ratio was not confirmed, mostly being 25?%. Artefacts were worse and acquisitions took slightly longer at 3?T.

Conclusion

Objective evidence to guide MRI purchasing decisions and routine diagnostic use is lacking. Rigorous evaluation accuracy and practicalities of diagnostic imaging technologies should be the routine, as for pharmacological interventions, to improve effectiveness of healthcare.

Key Points

? Higher field strength MRI may improve image quality and diagnostic accuracy. ? There are few direct comparisons of 1.5 and 3?T MRI. ? Theoretical doubling of the signal-to-noise ratio in practice was only 25?%. ? Objective evidence of improved routine clinical diagnosis is lacking. ? Other aspects of technology improved images more than field strength.     

Elimination of Lymphatic Filariasis: Mass Drug Administration in Endemic Areas of (Bidar District) Karnataka-2008

Background:

Lymphatic Filariasis is a mosquito transmitted disease, caused by parasitic worm Wuchereria bancrofti. Global Programme for Elimination of Lymphatic Filariasis was established in early 2000. The strategy recommended by the World Health Organization is annual Mass Drug Administration (MDA) of single-dose of Diethylcarbamazine 6 mg/kg (DEC), distributed to inhabitants of Filariasis endemic areas, excluding children below 2 years of age, pregnant women, and seriously ill persons, and Morbidity Management. The health system distributes the drugs by a door-to-door strategy.

Objective:

To assess the coverage and compliance of MDA in Bidar district during the campaign in November 2008.

Materials and Methods:

Cross-sectional population-based house-to-house visit. Outcome is assessed as actual coverage and compliance, in Percentage and proportions.

Results:

Eight clusters, total eligible population of 1 131 individuals were interviewed. The coverage rate was 78% with variation across different areas. The compliance with drug ingestion was 68%.

Conclusion:

The effective coverage was below the target (85%). Side effects of DEC were minimum, the overall coverage was better in rural areas compared with urban areas.     

Identification of Bakb, a new platelet-specific antigen associated with posttransfusion purpura

Baka is a platelet alloantigen whose putative allele, Bakb, has not been identified previously. By using a serum, "Har," obtained from a patient with posttransfusion purpura, we describe the platelet alloantigen Bakb. The Har serum reacted with an NP-40-extractable platelet membrane protein of 142 kd with mobility similar to platelet glycoprotein IIb alpha. We found that the antigen recognized by the Har serum is inherited in an autosomal dominant mode with an apparent gene frequency of .39. Chi-square analysis of observed and expected phenotype frequencies indicated that serum Har recognizes Bakb, the anticipated allele of Baka. Our findings provide new evidence for polymorphism of glycoprotein IIb and for the association of posttransfusion purpura with alloimmunization to determinants on this glycoprotein.